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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.4 PCP/Main Dentist Guidelines for Medicaid Managed Care Clients : 2.4.3 PCP and Main Dentist Changes

2.4.3
PCP and main dentist changes may be requested or initiated by any of the following:
Any request by a provider to reassign a client to another PCP or main dentist must be processed through the applicable Medicaid MCO or dental plan. Before a request for reassignment can be initiated, reasonable measures must be taken to correct the client’s behavior. Reasonable measures may include education or counseling by the MCO or dental plan staff. The MCO or dental plan will notify the client of the reassignment if all attempts to remedy the situation have failed. Providers should also notify the client about the reassignment in writing and send a copy of the notification to the MCO or dental plan.
The MCOs and dental plans can affect a PCP or main dentist change immediately if necessary; however, the Medicaid client eligibility verification systems may not immediately reflect the change.

Texas Medicaid & Healthcare Partnership
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